• Stefanie Theresa Jost, Anna Sauerbier, Veerle Visser-Vandewalle, Keyoumars Ashkan, Monty Silverdale, Julian Evans, Philipp A Loehrer, Alexandra Rizos, Jan Niklas Petry-Schmelzer, Paul Reker, Gereon Rudolf Fink, Jeremy Franklin, Michael Samuel, Alfons Schnitzler, Michael Thomas Barbe, Angelo Antonini, Pablo Martinez-Martin, Lars Timmermann, K Ray-Chaudhuri, Haidar S Dafsari, and EUROPAR and the International Parkinson and Movement Disorders Society Non-Motor Parkinson's Disease Study Group.
• Department of Neurology, University Hospital Cologne, Cologne, Germany.
• J. Neurol. Neurosurg. Psychiatr. 2020 Jul 1; 91 (7): 687-694.

ObjectiveTo examine 36-month effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on non-motor symptoms (NMS) compared with standard-of-care medical treatment (MED) in Parkinson's disease (PD).MethodsHere we report the 36-month follow-up of a prospective, observational, controlled, international multicentre study of the NILS cohort. Assessments included NMSScale (NMSS), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD (SCOPA)-motor examination, -activities of daily living, and -complications, and levodopa equivalent daily dose (LEDD). Propensity score matching resulted in a pseudo-randomised sub-cohort balancing baseline demographic and clinical characteristics between the STN-DBS and MED groups. Within-group longitudinal outcome changes were analysed using Wilcoxon signed-rank and between-group differences of change scores with Mann-Whitney U test. Strength of clinical responses was quantified with Cohen's effect size. In addition, bivariate correlations of change scores were explored.ResultsPropensity score matching applied on the cohort of 151 patients (STN-DBS n=67, MED n=84) resulted in a well-balanced sub-cohort including 38 patients per group. After 36 months, STN-DBS significantly improved NMSS, PDQ-8, SCOPA-motor examination and -complications and reduced LEDD. Significant between-group differences, all favouring STN-DBS, were found for NMSS, SCOPA-motor complications, LEDD (large effects), motor examination and PDQ-8 (moderate effects). Furthermore, significant differences were found for the sleep/fatigue, urinary (large effects) and miscellaneous NMSS domains (moderate effects). NMSS total and PDQ-8 change scores correlated significantly.ConclusionsThis study provides Class IIb evidence for beneficial effects of STN-DBS on NMS at 36-month follow-up which also correlated with quality of life improvements. This highlights the importance of NMS for DBS outcomes assessments.© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

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